A Case of Mixed Type Renal Tubular Acidosis with Primary Sjögren`s Syndrome

Korean Journal of Nephrology 2007;26(5):619-624.

Dong Hun Lee, M.D., Young Ki Lee, M.D., Jin Kyung Kim, M.D., Mi Kim, M.D. Chong Won Sung, M.D., Joo Hyun Jang, M.D., and Jung Woo Noh, M.D.

Department of Internal Medicine, Hallym Kidney Research Institute College of Medicine Hallym University, Seoul, Korea

Sjögren 증후군에 동반된 혼합형 신세뇨관 산증 1예

이동훈 이영기 김진경 김 미 성종원 장주현 노정우

한림대학교 의과대학 내과학교실, 신장연구소

Abstract

56-year old woman was hospitalized for severe weakness and generalized bone pain, so she was immediately evaluated for the multiple bone lesions under the impression of malignancy with bone metastasis at the department of oncology. No underlying malignancy was found and the patient was referred to the division of nephrology, where patient was diagnosed as mixed type renal tubular acidosis(RTA) with clinical features of both type 1 and type 2 RTA. Type 2 RTA was diagnosed by high fractional excretion of bicarbonate over 15% and multiple bone lesions, and type 1 RTA was diagnosed by the presence of nephrocalcinosis and sustained high urine pH over 7.0 in spite of severe metabolic acidosis (pH <7.2) with low serum bicarbonate level. She also had findings characteristic of primary Sjögrens syndrome. The treatment started with sodium bicarbonate, vitamin D, calcium and analgesics. In the following seven months, acidosis and symptoms such as bone pain were improved gradually.